Do you care about the Super Bowl? I mean do you really care who wins or are you just watching for the commercials? If you are invested in the game, there are a few things you should know. The first is this: if your team loses, it could be bad for your health. Spectacularly bad. So bad that clinical investigators now routinely review death certificates in the days following the Super Bowl—and the results are grim.

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Heart Attacks And The Super Bowl

In the eight-day period after the Patriots unexpectedly lost the 2008 Super Bowl to the New York Giants, deaths attributed to heart attacks went up 24% in Massachusetts. Conversely, when the Steelers beat the Arizona Cardinals the following year, deaths from heart attacks decreased by 46% in Pittsburgh.1 Is this coincidence? Maybe.2 But the researchers only did these studies because death rates in LA famously went up in the two weeks after the Los Angeles Rams lost Super Bowl XIV to the Steelers. And you thought the players were the only ones who might get hurt.

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This is a phenomenon that's been observed around the world, for different, massive sporting events. It turns out there's an increase in heart attacks in Brazil when Brazil plays in the World Cup. And the same thing happens in Germany when the German team plays in the World Cup (During the 2006 FIFA World Cup a New England Journal of Medicine paper showed that in Munich, the risk of a heart attack more than doubled when Germany was playing. That's insane!) And it turns out the same thing happened in England after a stressful World Cup match: "Risk of admission for heart attack increased by 25% on 30 June 1998 (the day England lost to Argentina in [Ed: of course] a penalty kick shootout) and the following two days. No excess admissions occurred for other diagnoses or on the days of the other England matches."

The risk of death was far more tenuous in these foreign studies—in fact, the same researchers looked at German fans and found that during the 2006 World Cup there wasn't an increased risk of stroke—but replicable links to heart attack across types of high-stake sporting events are still fascinating, and worrying.

They aren't exactly inexplicable, though. Heightened stress causes heart attacks. A surge of adrenaline and cortisol and can cause blood vessels to constrict, forcing the heart to pump harder than it's normally able to, causing angina. If it works too hard, the heart cells become starved for oxygen and die, causing a heart attack. As The New England Journal authors write in their introduction, "events that induce environmental stress in a large number of people in defined areas—such as earthquakes, war, and sporting events—may increase the risk of cardiovascular events."

(There's a disease called Takotsubo's cardiomyopathy where bad news—classically the death of a loved one—causes someone to immediately have heart failure. That's what you've seen in a movie, and that's what it means to die of a broken heart.)

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The Hospital? And Miss The Game?

After the Super Bowl kicks off, we know that people will delay seeking medical care, even when there's an emergency. Chest pain can wait but that Marshawn Lynch stiff-arm apparently cannot. Not surprisingly, Super Bowl Sunday tends to be the slowest day of the month in the Emergency Room. In fact, this has also been demonstrated across the globe. Decreased visits to the ER have been observed during UEFA Champions League games and during the Rugby World Cup. There hasn't been as much research about ER traffic during a Super Bowl, but using patient census data from 1988-1992, four of the five years showed significant drops in emergency department use during the Super Bowl, with a larger effect in the home cities of the participants.

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Perhaps it's time to put more televisions in the waiting room. Interestingly, traffic to a pediatric ER does not decrease during the Super Bowl, so fans are willing to take their sick kid to the doctor.

Stay Off The Roads

Lastly—and this should go without saying—don't get in a car with someone who has been drinking after the game. In fact, consider not driving at all. Research has shown that there's a 41 percent increase in driving related fatalities immediately after the Super Bowl. This is a subtle point but what they've found is that the period immediately after the Super Bowl is more dangerous than randomly driving at any time on New Year's Eve. There are more total fatalities on NYE because it's a long, relatively dangerous time to drive whereas Super Bowl Sunday is safe until after the game. The most dangerous days to drive continue to be holidays: Memorial Day, July 4th, NYE, and Labor Day because people are drinking and driving all day.

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We can expect roughly eight percent of fans leaving the Super Bowl to be legally intoxicated. (It might be even higher for people watching at a Super Bowl party.) An interesting proposal that hasn't gained any traction: Experts have suggested that beer sponsors should subsidize public transportation after the Super Bowl.

Another thing to consider: Distracted driving (people looking at twitter and facebook after the game) might make driving more dangerous after the Super Bowl but no one has studied it yet.

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Of course, I know you're going to watch the Super Bowl. I am too. But just because you'll spend Sunday evening thinking about the status of Peyton Manning's neck doesn't mean you can't also keep in mind how to save your own.

1 Cardiovascular death rates did not change in Arizona after the Cardinals loss to the Steelers, which led researchers to conclude that, "Massachusetts and Pittsburgh show stronger support for their home teams compared with Arizona." Sorry, Cardinals fans, but without a few more heart attacks we can't be sure you really care. http://link.springer.com/article/10.100…